Universal Adverse Effects & Long-term Consequences of LASIK

Joe R. McFarlane Jr., MD: "We are also just now learning of some of the long-term complications of [LASIK], which are being reflected in new allegations and lawsuits. For example, some patients are developing postrefractive ectasia years after the procedure; this condition not only compromises vision, but also may need to be treated with a corneal
Source: EyeNet Magazine, November 2007.

LASIK surgeons are aware of universal adverse effects and long term consequences of LASIK, but this information is not fully disclosed to patients prior to Lasik.

Problems from Lasik? File a MedWatch report with the FDA online. Alternatively, you may call FDA at 1-800-FDA-1088 to report by telephone or download the MedWatcher Mobile App for reporting LASIK problems to the FDA using a smart phone or tablet. Read a sample of LASIK injury reports currently on file with the FDA.

Patients with LASIK complications are invited to join the discussion on FaceBook

Incomplete healing of the cornea and lifelong risk of late flap dislocation

The LASIK flap never heals. A relatively weak scar forms at the flap margin, which holds the flap in place, but the flap itself does not bond to the cornea. Peer-reviewed medical literature contains numerous reports of flap dislocations occuring years after LASIK. Patients should be informed of this risk prior to undergoing LASIK.

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Permanent loss of corneal strength after LASIK and risk of late onset corneal ectasia

The cornea is under constant stress from normal intraocular pressure pushing outward. Collagen bands of the cornea provide its form and biomechanical strength. LASIK thins the cornea and severs collagen bands, permanently weakening the cornea. This results in forward bulging of the posterior cornea, which may progress to anterior steepening -- a condition known as post-LASIK corneal ectasia, or keratectasia, characterized by loss of best corrected vision and possible need for corneal transplant. Corneal ectasia may develop months or years after seemingly 'successful' LASIK.

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Inaccurate intraocular pressure measurement after LASIK

Refractive surgery alters corneal thickness and biomechanical properties of the cornea. Consequently, the measurement of intraocular pressure (IOP) is inaccurate after LASIK. IOP measurement is critical in the diagnosis of ocular hypertension and glaucoma risk. Patients who have had LASIK may lose vision due to undiagnosed glaucoma.

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Problems with cataract surgery after LASIK

Everyone will develop cataracts if they live long enough, including patients who have had LASIK and other forms of refractive eye surgery. Cataract surgery involves removal of the natural lens inside the eye and implantation of an artifical intraocular lens (IOL). The altered corneal shape after LASIK results in inaccurate measurement of the intraocular lens power for cataract surgery. This means that patients who have LASIK surgery and later develop cataracts may be right back in glasses after cataract surgery -- or worse, subjected to the inherent risks of multiple corrective surgeries. Moreover, studies have found that Lasik patients undergo cataract surgery 10 – 15 years earlier than people who have not had previous eye surgery, which suggests that Lasik may lead to early cataracts.

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Progressive loss of corneal cells (keratocytes) after LASIK

Published medical studies have shown a persistent decrease in corneal cells (keratocytes) after LASIK. Doctors speculate that this loss might lead to long-term problems.

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Long-term corneal nerve damage after LASIK

Corneal nerves responsible for tear production are severed and destroyed during LASIK. Microscopic examinations of post-LASIK corneas show the reduction in corneal nerves after LASIK persists for years. No study at any time point has found that corneal nerves fully recover after LASIK to normal densities and patterns. Damaged nerves may lead to chronic dry eyes and/or intractable corneal neuropathic pain.

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Increased risk of eye infections

"Eyes that have undergone LASIK may be more pre-disposed to infections than unoperated eyes, and the infection may progress more rapidly when it occurs. A possible explanation for the presentation of delayed keratitis after LASIK is that creating the lamellar flap may induce a permanent portal in the corneal periphery for microorganisms to penetrate."

Source: Vieira et al. Late-onset Infections After LASIK. J Refract Surg. 2008 Apr;24(4):411-3.

Loss of visual quality - Increase in visual aberrations

LASIK clinical trials demonstrate that LASIK routinely leads to loss of visual quality, which is demonstrated by an increase in visual aberrations not correctable with glasses (higher order aberrations). Simply stated, patients generally do not see as well in dim light after LASIK as they did with their glasses. The FDA website warns that LASIK patients may develop debilitating visual symptoms that can seriously affect nighttime vision.

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Disclaimer: The information contained on this web site is presented for the purpose of warning people about LASIK complications prior to surgery. LASIK patients experiencing problems should seek the advice of a physician.